“This is a bigger bailout for the insurance industry than AIG,” former Democratic National Committee chairman and medical doctor Howard Dean told “Good Morning America’s” George Stephanopoulos today. “A very small number of people are going to get any insurance at all, until 2014, if the bill works.

“This is an insurance company’s dream, this bill,” Dean continued. “This is the Washington scramble, and I think it’s ill-advised.”

Dean sent shockwaves when he said Tuesday in an interview with Vermont Public Radio that the removal of the Medicare buy-in means Democrats should just kill the health care bill and start over.

“This is essentially the collapse of health care reform in the United States Senate,” Dean said. “Honestly, the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”

[…]

He said he also doesn’t see cost-control measures but, rather “a whole bunch of bureaucracies and a lot of promises.”

There are some good elements in the current health care bill, Dean said, but “at this point, the bill does more harm than good.”

I was very pleased by the solidarity with which the left, loosely defined, defended the ACA from Ryan and McConnell. From DSA to Joe Manchin, almost everybody recognized the urgent necessity of killing the repeal bills, and countless people observed that repeal would inflict large amounts of preventable death, suffering, and financial ruin. But what’s amazing at the time is that a non-trivial number of the people making Dean’s 2017 argument that repealing the ACA would be a “disaster” spent years arguing for Dean’s 2010 view that the ACA was a BAILOUT of insurance interests that accomplished little or nothing or maybe even worse than nothing. This was the view, for example, of Adolph Reed’s widely praised Harper’s cover story, and is the implicit claim of arguments that Obama governed in Reagan’s paradigm rather than FDR’s. As Chait says, “It is logically impossible for the repeal of an insignificant reform to be catastrophic. If it is a big deal to uninsure 24 million Americans and cut taxes on the rich, then it must be a big deal to insure 24 million and raise taxes on the rich.” I’m glad that the threat of repeal concentrated people’s minds, but it’s important not to keep making the analytical mistakes that led to the initial mischaracterization of the ACA.

The transparently false claim that the ACA was not an incredibly hard-fought reform that is one of the most important achievements of the New Deal tradition of Democratic governance but a minor or perhaps even counterproductive reform was based on using the wrong baseline, comparing the ACA not to the status quo ante but to European systems. The passage of an ACA-like model by veto-proof supermajorities of Massachusetts Democrats but signed by a Republican governor encouraged the belief that something like the ACA was just the consensus position of both parties, and the only question was whether Obama, Pelosi, and Reid could do better. This idea is transparently speciois, completely misunderstanding the basic ideological divisions between the two parties that started with the New Deal and have only gotten sharper.

We can see this in a couple of our recent discussions. In yesterday’s McConnell thread, for example, multiple people said that actually McConnell is incompetent because if he knew what he was doing rather than pursuing a long-odds battle to inflict major damage to the ACA, he should have just passed a bipartisan bill to stabilize the exchanges or something and called it a day. The obvious problem with this argument is that McConnell and the vast majority of the Republican conference in both houses don’t want that. They wanted to inflict real damage on the ACA and make it fail because it represents everything they hate. I mean, did you watch the vote and McConnell’s subsequent speech? If McConnell was presiding over a kabuki he strongly wanted to fail, they should cancel the Best Actor Oscar and just give it to McConnell in perpetuity. And you don’t make even marginal senators up for re-election in 2018 vote for an empty gesture you want to fail. Saying McConnell should have just worked with Democrats to pass a bipartisan bill to help the exchanges work is like saying that Reid and Pelosi were incompetent because instead of trying to pass cap-and-trade they should have just passed a bipartisan bill subsidizing the Keystone pipeline and increasing defense spending.

Subsidies to allow the non-affluent to purchase comprehensive insurance

The core elements of the ACA that Republicans should logically like are “none of them.” The Republican Party has for time out of mind been organized in opposition exactly to this kind of reform. Its coalition has become more homogeneous and its opposition to spending for the poor and tax increases on the rich more intense, but it’s a difference of degree. Republicans inflicted a lot of damage on themselves desperately trying to repeal the ACA because they hate everything the ACA stands for and always have. It’s really not complicated. It’s hard for them to repeal the ACA because their ideas have no mass constituency and it’s hard even for popular major legislation to make it through James Madison’s sausage factory. But Republican public officials despise the ACA for perfectly logical reasons.

There are some political issues (gun control being one example) on which the minority is much more intense and omitted than the majority. TrumpCare is the opposite: the majority was also much more committed. On one hand:

Murkowski told me that at every Alaska airport she went to over the weekend, people came up to her thanking her for her vote, some in tears.

On Monday, White House senior advisor Jared Kushner spoke to a group of congressional interns as part of an ongoing, off-the-record summer lecture series. During the question-and-answer portion of the event, Kushner may have inadvertently offered some insight into the negotiating tactics he is using in the Middle East.

Prior to Kushner’s talk, Katie Patru, the deputy staff director for Member Services, Outreach & Communications, told the assembled interns, “To record today’s session would be such a breach of trust, from my opinion. This town is full of leakers and everyone knows who they are, and no one trusts them. In this business your reputation is everything, I’ve been on the hill for 15 years. I’ve sat in countless meetings with members of congress where important decisions were being made. During all those years in all those meetings, I never once leaked to a reporter. …. If someone in your office has asked you to break our protocol and give you a recording so they can leak it, as a manager, that bothers me at my core.”

WIRED has obtained a recording of Kushner’s talk, which lasted for just under an hour in total.

[…]

While the recording doesn’t catch the entirety of the question, it appears to center on how Kushner plans to negotiate peace between Israelis and Palestinians, as well as why he believes he’ll be successful where every other administration has failed. He doesn’t directly answer either question, but he does reveal that, from his extensive research, he’s learned that “not a whole lot has been accomplished over the last 40 or 50 years.” He also notes that he’s spoken to “a lot of people,” which has taught him that “this is a very emotionally charged situation.”

[…]

Finally, Kushner closed with the following statement of reassurance: “So, what do we offer that’s unique? I don’t know… I’m sure everyone that’s tried this has been unique in some ways, but again we’re trying to follow very logically. We’re thinking about what the right end state is. And we’re trying to work with the parties very quietly to see if there’s a solution. And there may be no solution, but it’s one of the problem sets that the president asked us to focus on. So we’re going to focus on it and try to come to the right conclusion in the near future.”

Every once in a while people make the point that much of what eventually became Obamacare came from, of all places, the Heritage Foundation – that is, the ACA is basically what conservatives used to advocate on health care. So I recently reread Stuart Butler’s 1989 Heritage Foundation lecture, “Assuring Affordable Health Care For All Americans” – hmm, where have I seen similar language? — to see how true that is; and the answer is, it really is pretty much true.

First of all, this wasn’t just one guy at Heritage writing: Butler referred to his proposal as “the Heritage plan”, referring to a monograph that lays it out and does indeed present it as the institution’s policy, not just his opinion.

Second, while the Heritage plan wasn’t exactly the same as ObamaRomneycare, it was pretty close. Like the ACA, it imposed a mandate requiring that everyone buy an acceptable level of coverage. Also like the ACA, it proposed subsidies to make sure that everyone could in fact afford that coverage. That’s two legs of the three-legged stool.

[…]

Overall, what’s striking about the Heritage plan is that it’s not notably more conservative than what Obama actually implemented: a bit less regulation, a substantial amount of additional spending. If Obamacare is an extreme leftist measure, as so many Republicans claim, the Heritage Foundation in the 1980s was a leftist institution.

The claim that that the Heritage plan is “not notably more conservative than what Obama actually implemented” is just flatly false. The plans are radically different, and indeed the Heritage Plan has far more in common with the AHCA and BCRA than the ACA. We’ve been through this before, but to summarize again:

The ACA contained a historic Medicaid expansion that has led to millions of poor people receiving health insurance, and would have insured many more without the unholy alliance between the Supreme Court and sociopathic Republican public officials. The Heritage Plan wanted to replace Medicaid with bad catastrophic insurance. In and of itself, this difference renders claims that the ACA was essentially similar to the Heritage Plan false.

The ACA preserved Medicare and employer-provided insurance. The Heritage Plan would have eliminated them, requiring everyone to buy insurance on the individual market. Again, in and of itself this is a difference that renders assertions that the plans are essentially similar false.

But even if we just consider the exchanges, the comparison fails. It is true that there is a superficial structural similarity, but this just reflects the self-evident truths that 1)insurance not provided by the public has to be provided by markets and 2)health insurance markets don’t work if healthy people don’t have incentives to maintain coverage. (The Heritage Foundation hardly holds a patent on these banal observations.) But the regulatory differences between the Heritage exchanges and the ACA’s exchanges are far from minor. The essential benefits requirements of the ACA required insurers to offer comprehensive insurance to sell on the exchanges. The Heritage Plan not only did not have such requirements, it was designed to incentivize the purchase of catastrophic insurance, because its architects wanted most healthcare expenses to be paid out of pocket.

The differences between the two plans are greater in sum than in comparisons of individual parts (which are massive in themselves.) The difference between giving people tax credits to buy catastrophic insurance is substantial enough under the ACA’s structure, where the individual market is there to mop up the minority of people who aren’t covered by employers, Medicare, or Medicaid. Under the Heritage structure, where everybody is buying insurance from the individual market, the differences between the regulatory structures of the exchanges is hugely important.

I understand why people on the left who hate the Democratic Party and are emotionally committed to minimizing the difference between the Republicans and Democrats make this false argument. But Krugman strongly supports the ACA, and he was one of the first national pundits to recognize the Republican Party for what it is. I really don’t get it.

But I do want to emphasize again that this argument is not merely false, but politically toxic. It plays into the hands of hucksters like Avik Roy, who assert that of course conservatives want to cover everyone, but they just want to use markets. But what conservatives really want is for Congress to bring them the heads of Medicaid and Medicare, and if a Republican proposal inflicts major damage on one or the other, it turns out that they can live with Congress doing little or nothing to help poor people by private insurance. The Heritage Plan is much more accurately viewed as a plan to destroy all public insurance than a serious plan for universal coverage. And erasing the Medicaid expansion from the ACA, which Krugman’s analysis does, helps people like John Cornyn, whose speech before the vote on the HCFA attacked the ACA for leaving many poor Texans uninsured, hoping that many people wouldn’t know that this was the case because Texas turned down the Medicaid expansion.

In short, the claim that the ACA is similar to the Heritage Plan (and the implicit claim that the ACA is the policy outcome that conservatives have generally favored) is both demonstrably false and extremely damaging politically. I really wish Krugman — again, an otherwise invaluable voice — would stop making it.

Given the understandable and in some cases salutary felt need to push back against McCain since delivering the final vote will gives him a disproportionate amount of attention/credit, I think it’s worth making some distinctions. I agree entirely with Josh Holland and Sarah Jones that it’s inappropriate to (unironically) call McCain a hero for the vote. He’s not. Nor, for that matter, are the legislators with much better track records. If there are any heroes in this process, it’s the don’t-call-them-ordinary people who laid their bodies on the line. Protecting major progressive achievements is an inherently collective enterprise, just like passing them — so many moving parts have to fit it always seems like a miracle in retrospect, and it’s never about one person. (This why I’ve never liked calling the ACA “Obamacare” — it writes everybody else out of the story. I think we’d all realize it would be gross to call the Voting Rights Act “LBJRights.”) While we’re here, let me give a shout out to each and every New Hampshiran who could have listened to “Voting for CORPORATE DEMOCRATS is for SQUARES, man” horseshit but instead came out to vote for Maggie Hassan, delivering a 1,000 vote margin that very well may have saved health insurance for more than 20 million people.

But on Twitter I’ve seen a fair amount of people wanting to deny McCain credit for his vote because it was cast for the wrong reasons, of whatever. This is not merely wrong, but actively pernicious. The minor reason is that theater criticism of politicians is a massive bullshit dump, and often the just-so stories don’t really hold up on inspection. One story is that McCain is just a bully paying Trump back for insulting him and/or McConnell for working to kill his signature legislative achievement. The problem with this is that it can’t explain why McCain has been a good Republican solider until now. You can say he wanted to wait until it would be maximally painful, but he could not have known that he would be in position to deliver the death blow to TrumpCare. If, say, Dean Heller had any interest in employment as a United States Senator after 2018, McCain’s vote would have been irrelevant. McCain’s vote was presumably some combination of personal grudges, commitment to the Senate as an institution, terminal illness focusing his concentration on the monstrousness of the bill, and numerous other factors it’s pointless to try to weigh precisely.

Is McCain a hero for his vote? He’s not. Should we emphasize the 48 Dems who defended the ACA without lying about it and the 2 women in the Republican conference who had their necks out for longer so McCain doesn’t get disproportionate credit? Absolutely. But all 51 votes were necessary to kill this thing, and McCain’s counted the same as everyone else’s. It doesn’t matter why he did it. It matters that he did.

Blyleven and Raines are the two inductions where the influence of sabermetrics played a major role, and in Raines’s case Jonah had a major personal impact. I looked roughtly like he did while watching this. (I also have to add that for just sheer fun-to-watch, it’s hard to top a Hall of Fame class of Pudge/Bagwell/Raines.)

Yet Democrats give Mr. Schumer — song-belting, frequently badgering, endlessly frenzied — credit for his tireless attention to senators from every faction, and for quiet outreach to Republicans who he thinks could be partners down the line.

He has worked carefully — far more than Mr. Reid, many Democrats agreed — to be almost relentlessly inclusive, talking with them at all hours of the day, over every manner of Chinese noodle, on even tiny subjects, to make them feel included in strategy. Recently, as he sat in a dentist’s chair waiting for a root canal, he dialed up Senator Richard Blumenthal of Connecticut to talk about a coming judiciary hearing concerning Donald Trump Jr.

“I think he makes it look easier than it is,” Mr. Blumenthal said about Mr. Schumer.

Zero Democrats voting for any version of TrumpCare in either house might look inevitable in retrospect, but it’s harder than it looks.

And let’s give the individual red-state senators their due credit, too. Heidi Heitkamp represents a state Trump won by 36 points and was steadfast in opposition to TrumpCare. Joe Manchin represents a state Trump won by 42 points and is up for re-election in 2018 and was rock solid against TrumpCare from day 1. It’s easy to say that this should have been easy because TrumpCare would be particularly devastating for West Virgnia, only the state’s Republican senator didn’t give a damn. TrumpCare would have been really horrible for Nevada, too, and Heller is up in 2018, and he still folded like a $10 lawn chair. As you may have noticed, party polarization is substantial and accelerating, and every election counts.

In conclusion, the Republican Party should be ceded 70 or so votes in the Senate until people who agree with Brooklyn leftists about everything can be elected in jurisdictions like North Dakota and West Virginia.

With this said, though, Lisa Murkowski’s vote was just as important. And she didn’t budge in the face of endless lobbying from her colleagues and tactless and perhaps counterproductive threats from the White House defined by patterns of abuse and bad-acting. Both mathematically and substantively, McCain’s headline moment was only possible because Murkowski and Collins were there, consistently over time and under withering pressure to fold. They persisted.

Murkowski deserves a huge, huge amount of credit for her vote. But to my mind, Collins is really the stand out here. Collins made clear pretty much from the beginning of this latest process that her vote was not available at all. Not for motions to proceed, not for votes on the various different flavors of Trumpcare. Her vote, though only one vote, made McConnell’s margin dramatically tighter and ultimately too tight. She was matched with Paul and Heller at one point and finally with Murkowski and McCain. But she was there throughout.

As we discussed at various points throughout this long process, now probably but not certainly concluded, legislative politics all comes down to narrowing margins so political pressure can be concentrated on weak points, marginal votes. Collins was the lever making pressure on others possible. It is important to note that once a legislator makes their intentions clear like that they suddenly matter much less in terms of press attention, pay offs, special deals and the like. Paradoxically, the most critical person gets the least glory and attention. Her consistent opposition was a big, big deal.

Nor should we forget the fact that 48 Democrats were consistently ‘nos’ to everything throughout. This seems obvious now, given how everything turned out. It was clearly easier to accomplish in a highly polarized climate and with a smaller caucus than it was in 2009. But in a caucus that stretches from Bernie Sanders to Joe Manchin don’t underestimate the difficulty. Chuck Schumer kept his caucus 100% locked down throughout. That is a big, big deal and easy to underestimate.

With all this, though, all of the politicians were like small boats on a vast ocean. They made critical choices – some to their honor, Murkowski, others to their infamy, Heller; they executed strategies. But small boats on a vast ocean, no matter how expert their navigation, are ultimately subject to and at the mercy of waves and winds and tides. And here, to extend our metaphor, the ocean and the tides were activists and non-activists making phone calls, showing up at townhalls, emailing, in some cases reaching beyond partisan affiliation to say in various ways that this was not right. The victory here is really millions, tens of millions of people who made noise on a sustained basis over months. Noise is comparatively easy; sustained noise over months is seldom possible. It is an immense and bracing victory for what was at the end of the day very much grass roots, organic activism. Republicans were finally unable to overcome the common sense logic that the true measure of reform in the public interest was how a piece of legislation helped or harmed how many people.

McCain’s vote was critical to ensure that the rest of the efforts weren’t in vain, and I’ll return to it later. But Collins being a clear no early was indeed huge. And Murkowski had to deal with the most pressure (much of it ham-handed) — I would guess because McConnell knew Collins had gubernatorial ambitions and was probably a lost cause. The corporate neoliberal Democrat Party providing zero votes in either chamber despite being pretty much the same as the Republicans is easy to take for granted but was critical — Pelosi was great as always, and Schumer is proving to be a worthy successor to Reid, and Manchin and Heitkamp proved yet again that any Democrat is vastly preferable to any Republican in this context. And, of course, it all starts at the grassroots — I won’t try to top Erik but that’s where to begin.

This is, above all, a victory for the American public. The so-called “skinny repeal” bill that was killed this morning would have led to 16 million people losing their health insurance and caused premiums to skyrocket. It would have resulted in millions of people losing employer-provided coverage and destroyed the individual insurance markets in many states. It would have savagely cut funding for women’s health services and public health funding. Sen. Lindsey Graham (R-S.C.) called it a “disaster” — so you can imagine what people who didn’t vote for it thought.

And a bill modified by a conference committee if this bill had passed would have almost certainly been even worse. It probably would have restored some or all of the draconian Medicaid cuts in the House and Senate bills, and eliminated even more of the Affordable Care Act’s crucial consumer-protection regulations.

So the most important recent expansion of the American welfare state has been preserved. It’s almost impossible to overstate the magnitude of this policy victory. Hundreds of thousands of lives have been saved. A great deal of suffering and countless medical bankruptcies have been averted. Dedicated protesters were celebrating outside of Congress, and they were right to.

This bill will also have a substantial political fallout. Oddly, McConnell did not release any further marginal votes even after he lost his majority. McCain and Sens. Susan Collins (Maine) and Lisa Murkowski (Alaska) — the latter two of whom voted no on the motion to proceed earlier in the week — were the only Republicans to vote “no.” The two most vulnerable Senate Republicans in 2018, Jeff Flake of Arizona and Dean Heller of Nevada, cast futile “yea” votes. As Pema Levy of Mother Jonesobserved: “The best outcome for Dems tonight was for bill to fail, while top targets Heller and Flake vote aye. Amazingly, that’s what happened.” And numerous House Republicans who face tough re-election fights in 2018 also voted for an incredibly unpopular bill without getting anything in return.

This doesn’t mean that Democrats will take over Congress in 2018. The Senate map is brutal for the Democrats, who may not be able to win the three seats they need to take over even in a wave election. The heavily gerrymandered House will also be a tough fight, although a winnable one.

But Democrats can worry about 2018 later. This was a major victory. Collins, McCain, and Murkowski deserve a lot of credit for bucking their party and doing what’s right for the country. Deserving even more credit is every member of the Democratic caucus in the House and Senate, all of whom were steadfastly opposed to every terrible Republican proposal. And the most credit goes to the many citizens who gave so much. Supporters of the ACA took to the streets, called, and wrote, and made the public aware of what a fiasco passing this bill would have been. McConnell’s failure is above all a triumph of democracy over a party whose leadership expressed stunning contempt for democratic norms.

Don’t kid yourself: the Republican Party remains a major threat to the American welfare state and democratic norms. The ACA might well have been saved my a margin of 1,000 votes in New Hampshire. But this is a victory eminently worth savoring.

…Susan Collins and Lisa Murkowski deserve a lot of credit too. Deserving even more are every member of the Democratic caucus, who were unwaveringly opposed. And the most credit goes to ordinary citizens who went to the streets, called, and wrote, and made this bill politically toxic. Cheers. The war for universal healthcare is far from over, but this is a huge win for the American people.

McConnell grimly staring at the floor, refusing to look at McCain? The giddy expressions from Bernie and Gillibrand as they realize one of the most reprehensible bills with a serious chance of being passed by the United States Congress is dead? [Italian chef’s kiss]